management in breech presentation Flashcards
what is a breech presentation ?
the lie of the fetus is longitudinal but the fetal buttocks lie in the lower segment of the uterus
what are the types of breech ?
complete or flexed breech
extended or frank breech
footling presentation
kneeling presentation
what does complete or flexed breech look like ?
the thighs and knees are flexed but the feet are clos to the buttock
what does extended or frank breech look like ?
the fetal thighs are flexed and the legs are extended next to its abdomen with its feet next to their ears
what does the footling presentation look like ?
one or both hips and knees are extended and the feet present below the buttock
what does the kneeling presentation look like ?
one or both hips are extended and the knees are flexed , the knees present below the buttocks
what is distinctively different in ballotment when it comes to flexed vs frank presentation ?
with the flexed presentation the head is free with fundal grip
with the frank position ballotment may be restricted
what is the denominator in the breech presentation ?
the sacrum
what is the recommended mode of delivery with the breech presentation ?
caesarian section
what can be done to reduce the rate of CS with breech presentation ?
external cephalic version ( 2e2leb el baby and deliver cephalic)
what are the unfavorable factors for vaginal breech birth ?
any contraindication to normal vaginal delivery ( placenta praevia, placenta accreta ) footling or kneeling breech presentation previous Caesarian section IUGR baby macrosomic baby
how should external cephalic version happen ?
only after 36 weeks confirm on US perform CTG administer tocolytics lie flat attempt forward somersault post procedure CTG
what are alternative methods to ECV ?
Moxibustion
maternal positioning
what is moxibustion ?
a certain plant that is burned near the little toe to cover are BL67 and is supposed to help with breech presentations
which breech positions can we deliver vaginal ?
either frank or complete breech and fetal head must be flexed
what is the golden rule for breech delivery ?
hands off
what is the mechanism of birth of breech ?
descent breech engages with the bi-trochanteric diameter internal rotation of the buttocks lateral flexion of the trunk birth of the anterior buttock first
what are the three ways in which the head can be delivered in ?
Burns Marshall’s method
Moriceau Smellie-Veit
Pipers forceps
what is the burns marshall’s method ?
let the baby hang down by its weight to allow for its weight to pull the head down and then fold the baby toward the mother and the head should come out
what is the Moriceau Smellie-Veit method ?
includes flexion of the jaw along with shoulder retraction
what is the advantage to using pipers forceps for delivery ?
force is only applied to the ventral aspects of the head and there is no compression on the neck of the baby so decreases the chances of intracranial hge
if there is a delay in the delivery of the legs what is the best next step in management ?
popliteal pressure should be applied to achieve knee flexion and thigh abduction
what is the best next step in management if there is a delay in the delivery of the arms
sweep arms on baby’s face and downwards
or
use the lovset maneuver which is rotation of the baby into the antero-posterior position
what should be done if there is a delay in the engagement of the head ?
apply suprapubic pressure
